Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome

A study of patients with a primary malignant brain tumour and their carers: symptoms and access to services.

The aim of this study is to investigate the symptom experience, access to supportive care services and rehabilitation of patients with a primary malignant brain tumour (PMBT) and their carers. Methods A case review of 70 patients with a diagnosis of PMBT who received palliative care in five specialist palliative care units between July 2005 and June 2006. The review examined patient’s symptom experience, care issues, access to rehabilitation and access to supportive care services. Results The two most significant issues experienced by patients and identified in the case review were hemiparesis (17%) and cognitive problems (16%). There were a number of care problems concerning safety related to mobility and falls (9%). Symptoms related to fatigue and tiredness were reported infrequently. There was an absence of information relating to the needs of informal carers; however 18% of carers accessed bereavement counselling services following the death of the person they cared for. Conclusion The needs of carers were not found to be routinely documented within the case notes. For some patients referral to specialist palliative care services occur late in the illness trajectory, which means that patients and carers may not be able to access the full range of supportive care services available. Initial assessment of patients should identify the range of support services that both carers and patients are offered; and the uptake and response to services should be documented throughout the illness trajectory

A study of patients with a primary malignant brain tumour and their carers: symptoms and access to services.

The aim of this study is to investigate the symptom experience, access to supportive care services and rehabilitation of patients with a primary malignant brain tumour (PMBT) and their carers. Methods A case review of 70 patients with a diagnosis of PMBT who received palliative care in five specialist palliative care units between July 2005 and June 2006. The review examined patient’s symptom experience, care issues, access to rehabilitation and access to supportive care services. Results The two most significant issues experienced by patients and identified in the case review were hemiparesis (17%) and cognitive problems (16%). There were a number of care problems concerning safety related to mobility and falls (9%). Symptoms related to fatigue and tiredness were reported infrequently. There was an absence of information relating to the needs of informal carers; however 18% of carers accessed bereavement counselling services following the death of the person they cared for. Conclusion The needs of carers were not found to be routinely documented within the case notes. For some patients referral to specialist palliative care services occur late in the illness trajectory, which means that patients and carers may not be able to access the full range of supportive care services available. Initial assessment of patients should identify the range of support services that both carers and patients are offered; and the uptake and response to services should be documented throughout the illness trajectory

Continuous problems: optimality, complexity, tractability

Since a digital computer is able to store and manipulate only with finitely many real numbers, most computational problems of continuous mathematics can only be solved approximately using partial information. A branch of computational mathematics that studies the inherent difficulty of continuous problems, for which available information is partial, noisy, and priced, is called information-based complexity (IBC). IBC emerged as a branch of computational mathematics some 30 years ago as a consequence of the need to study theoretical aspects of computations related to continuous problems. Since then IBC developed in different directions, see, e.g., the monographs [1, 2, 6, 7, 8, 9, 10, 11]. In IBC study, an important role, both theoretical and practical, play problems that are defined on functions of many or even infinitely many variables. In physical or chemical applications, the number o

A lower bound on convergence rates of nonadaptive algorithms for univariate optimization with noise

Global optimization, Wiener process, Noisy information,